Prediction of Bone Marrow Cellularity from Aspiration as compared to Trephine Biopsy

Background: Bone marrow cellularity is an essential and integral part of the bone marrow examination report. Cellularity could be obtained from both bone marrow aspirations and biopsies. Predicting marrow cellularity from aspiration as opposed to biopsy would give the clinician the convenience of an early diagnosis and timely management. In this study, we aimed at knowing the degree of correlation between the bone marrow aspiration cellularity that could be ready within a short period of time to that of bone marrow biopsy cellularity that could take days to have a positive impact on the management, especially for acute blood disorders. Materials and Methods: We collected 200 consecutive bone marrow aspirations from the Nanakaly Teaching Hospital. All the bone marrow biopsy slides belonging to the same group of patients were also collected from the main histology center at Rizgary Teaching Hospital. Five expert hematopathologists were given the chance to report on the cellularity for both the aspirations and the biopsies. The study was performed in sessions, limiting each session to 20 aspirations and 20 biopsies. Cellularity was rated in percentage points of 5 giving the observer the chance to rate the cellularity from 0% to 100%. Results: Microsoft Excel spreadsheet was used to record all the data obtained from the observers. Mean values from all the five observers for each aspiration and biopsy was used for statistical analysis. We found a strong direct positive correlation between the bone marrow biopsy cellularity and bone marrow aspiration cellularity. Conclusion: A simple practical equation could be created to measure bone marrow biopsy cellularity from the usually available aspiration cellularity. Marrow biopsy cellularity was found to be 0.96 of the aspiration cellularity

The trend in delayed childbearing and its potential consequences on pregnancy outcomes:a single center 9-years retrospective cohort study in Hubei, China

Background: Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes.Objective: To determine the trend in delayed childbearing and its negative impact on pregnancy outcomes.Material and methods: A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011–2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes.Results: Between 2011 and 2019, the trend in advanced maternal age (AMA ≥35 years) increased by 75% [AAPC 7.5% (95% CI: − 10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.5; 95% CI: 1.2, 2.1), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.8; 95% CI: 1.5, 2.2), gestational diabetes mellitus (aOR 2.5; 95% CI: 2.3, 2.9), preterm births (aOR 1.6; 95% CI: 1.4, 1.7), perinatal mortality (aOR 1.8; 95% CI: 1.3, 2.3), and low birth weight (aOR 1.3; 95% CI: 1.2, 1.4) compared with women aged &lt; 30 years. Conclusion: Our findings show a marked increase in delayed childbearing and its negative association with pregnancy outcomes.</p

The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal–perinatal outcomes among singleton and twin pregnancies:A retrospective cohort study (2011–2019)

Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal–perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal–perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. Methods: A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal–perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal–perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. Results: The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. Conclusion: In conclusion, GDM showed an increased risk of a few adverse maternal–perinatal outcomes and HDP is associated with a higher risk of several adverse maternal–perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal–neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.</p

The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal–perinatal outcomes among singleton and twin pregnancies:A retrospective cohort study (2011–2019)

Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal–perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal–perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. Methods: A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal–perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal–perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. Results: The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. Conclusion: In conclusion, GDM showed an increased risk of a few adverse maternal–perinatal outcomes and HDP is associated with a higher risk of several adverse maternal–perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal–neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.</p

Outcome of Post Induction Therapy for Acute Myeloid Leukemia in Nanakaly Hospital-Erbil

Background: Acute myeloid leukaemia in adult constitutes 80% of whole acute leukaemia cases; its frequency progressively increases with age. Objective: To evaluation the parameters of AML patients clinically and haematologically in Erbil City. Patients and Methods: A particular analysis of hospital records retrospective study of 29 patients with AML was taken on. The cases were analyzed and achieved at Nanakaly hospital in Erbil city during the years 20021-2022. Diagnosis was established on peripheral blood and bone marrow reports. The myeloid origin confirmation was concerned by cytochemistry, morphological subtyping was concerned according to the (FAB) criteria, biochemical tests, and cluster CDs was done by flowcytometery. Microsoft excel version 2010 and (GraphPad Prism 9.0.) was in employment for carrying out statistical analysis. Results: This study included 18 males and 11 females. Their ages ranged from 5 and 80 years with a mean age of 38.4 years. CD13 and CD33 are most expressed CD markers (75% and 70% respectively). CD22 and TdT lowest expressed CDs (10% and 5% respectively). Depending on the complete remission/Partial remission association, the p-value of platelets was significant (0.0207), CD64 and CD117 showed greater significant (<0.0001, <0.0001 respectively), BM hypercellularity fragments (P=0.0068), trials (P<0.0001), and blast percentage (P=0.0365). Conclusion: CDs and BM results are essential tools in the identification of AML. CD13 and CD33 are the most frequent CDs in this study. Morphologic valuation of BM was statistically significant, cellularity of BM and blast percentage was significantly correlated with post induction response in patients with AML

Health dynamics in war-torn Yemen:Insights from 32 years of epidemiological data (1990–2021)

BackgroundYemen is the poorest and war-torn country in the North Africa and Middle East region and lacks a comprehensive assessment of temporal trends in the overall disease burden, injuries, and disabilities at the country level; these insights are required to guide healthcare interventions and improve overall population health. We estimated the burden and temporal trends of diseases and their risk factors in Yemen between 1990 and 2021 using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021.MethodsIn this systematic analysis, we presented all-causes and cause-specific mortality rates, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), as well as the life expectancy at birth and health-adjusted life expectancy (HALE) using the standardized GBD methodology. Moreover, we compared the disease burden of Yemen with the top five war-torn countries based on the Global Peace Index (GPI) 2021, including Afghanistan, Syria, South Sudan, and Iraq.ResultsIn Yemen, the life expectancy at birth increased from 59.0 years (95% UI 56.4–61.8) in 1990 to 65.3 years (95% UI 62.2–67.9) in 2021. Between 1990 and 2021, the all-causes age-standardized mortality rate in Yemen decreased from 1471.7 deaths (95% UI 1268.4-1696.3) to 1347.2 deaths (95% UI 1097.5-1659.5). However, the age-standardized mortality rate caused by conflict and terrorism substantially increased from 1.9 deaths (95% UI 1.7–2.1) to 50.0 deaths (95% UI 45.5–55.0) between 2010 and 2021. In 2021, ischemic heart disease, COVID-19, stroke, hypertensive heart disease, conflict and terrorism, and neonatal disorders were leading causes of age-standardized mortality and YLLs rate. Dietary iron deficiency, low back pain, depressive disorders, headache disorders, anxiety disorders, and gynecological diseases were the leading causes of age-standardized YLDs rate in 2021. High blood pressure, high levels of low-density lipoprotein, smoking, low birth weight, and short gestations were the leading risk factors for age-standardized mortality in 2021. Yemen ranked 3rd in terms of high age-standardized all-causes deaths, YLLs, and lowest HALE at birth and lowest life expectancy at birth among the top five war-torn countries in 2021.ConclusionYemen must proportionately address the burden caused by non-communicable diseases, communicable, maternal, neonatal, and nutritional diseases, and conflict and terrorism. Prioritizing these areas will improve the overall population health and prevent premature mortality and disabilities

Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus

Background: Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. Methods: In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. Results: Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: − 2.64, p &lt; 0.001; DMM/US and/or previous tests: − 1.40, p &lt; 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented. Conclusions: The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.</p